HENRY COUNTY BOARD OF HEALTH MEETING Held Wednesday, March 15, 2017

Board Members Present Roger Richard, President Joel Miller, President Pro-Tempore Marilyn Bremer, RN Doug Lindsey, MD Sharon Miller Char Weber Al Wiederwohl HENRY COUNTY BOARD OF HEALTH MEETING Held Wednesday, March 15, 2017 Staff Present Anne Goon, MS, RD, LD, Health Commissioner Joy Ermie, MPH, Director of Community Health Services Julie Lauf, RN, Director of Personal Health Services Jon Lindsay, RS, Director of Environmental Health Services Julie McHugh, Fiscal Officer Bethany Wachter, MPH, Health Communications Specialist/Accreditation Coordinator Public Present Bob Hastedt, County Commissioner CALL TO ORDER AND INTRODUCTION OF GUESTS Roger Richard, President, called the Board of Health meeting to order at 12:35 p.m. The meeting was held in Conference Room A of the Henry County Health Department. A quorum was present. APPROVAL OF CONSENT AGENDA R12.17 Dr. Doug Lindsay moved to approve the consent agenda, consisting of the following items: A. Minutes of February 15, 2017, Board of Health meeting B. Management Reports for February 2017: 1. Health Commissioner s Monthly Activity Report 2. Community Health, Environmental Health, Personal Health, and Administration Monthly Section Reports 3. February 2017 Communicable Disease Report 4. February 2017 Service Statistics Report 5. Performance Management and Accreditation Reports C. Personnel 1. FML a. Continuation: Jennifer Huber, 2/18/17-3/31/17 Ms. Huber was originally approved for approximately 132 hours of intermittent Family Medical Leave (FML) from January 3, 2017, through February 17, 2017. The intermittent FML has been extended to March 31, 2017. b. Katelyn Britenriker, 6 weeks (~3/28/17-5/8/17) 1

Ms. Britenriker has been approved for 6 weeks of Family Medical Leave (FML) after the upcoming birth of her baby. D. Finance 1. Financial Statements The total cash balance for all funds combined for February 2017 increased by $42,378.08 to $3,063,936.41. The general fund balance was $1,483,268.04 at the end of February, an increase of $13,402.21 from January. The general fund balance ended February with 10.4 months of operating reserves (260% of the 2017 minimum fund balance goal). 2. Cash Basis Annual Financial Report (Unaudited) for Calendar Year 2016 The unaudited Annual Financial Report for 2016 was submitted to the Auditor of State on February 28, 2017. 3. Donations Donations totaling $1,082.25 for the benefit of Hospice and $30.00 for the benefit of Help Me Grow were received during February. E. Contracts and Agreements: 1. Nursing Facility Services Agreement for Hospice Services- Northcrest Rehab and Nursing Center The Nursing Facility Services Agreement was updated to reflect the name change for Northcrest and an increase in the General Inpatient (GIP) service rate for hospice services. 2. Personal Service Contract for Human Trafficking Speaking Engagement- Lee Campbell ($200.00) Ms. Campbell is contracted to speak at a human trafficking training event in June 2017. This cost is being funded through the Human Trafficking Awareness grant received from the Ohio Children s Trust Fund. 3. Marketing Service Agreement for White Pages Ad- Dex Media ($2,796.00) The agreement with Dex Media for the Henry/Fulton white pages phone book is renewed for $233.00/month to promote health department services. Marilyn Bremer seconded the motion. The motion passed unanimously. ACTION AND DISCUSSION ITEMS Health Commissioner s Report: Commissioner Goon provided updates on important activities completed during the past 30 days and/or occurring in the next 30 days: 1. 2016 Annual Report: Ms. Goon shared the 2016 Annual Report and thanked Bethany Wachter as the person responsible for creating the report. The report will be presented to the District Advisory Council (DAC) later this month for acceptance. 2. District Advisory Council (DAC) Annual Meeting: The annual DAC meeting will be held March 28, 2017, 6:00 pm, at Henry County Health Department. All Board of Health members are encouraged and welcome to attend the meeting. 3. 6-Pact Council of Government (COG) Project: Ms. Goon shared the 6-Pact health commissioners and Mid East Ohio Regional Council (MEORC) will be meeting on March 27, 2017. The goal of the meeting is to explore the various options for forming a public health COG without duplicating costs or infrastructure and achieve consensus about moving forward. This work is being funded by a research grant from The Ohio 2

State University (OSU) Center for Public Health Practice using funds secured by the Ohio Department of Health. PEOPLE Resolution Recognizing National Public Health Week and Employees and Board Members Years of Service R13.17 Joel Miller moved to recognize National Public Health Week and the service of Health District Staff and Board of Health members, as follows: Whereas, the week of April 3-9, 2017, is National Public Health Week, and the theme is Healthiest Nation 2030, with the goal of making the United States the healthiest nation in one generation; Whereas public health organizations use National Public Health Week to educate the public, policymakers, and public health professionals on issues that are important to improving the health of the people of the United States; Whereas the value of a strong public health system is in the air we breathe, the water we drink, the food we eat, and the places where we all live, learn, work, and play; Whereas public health professionals help communities prevent, prepare for, withstand, and recover from the impact of a full range of health threats, including disease outbreaks, natural disasters, and disasters caused by human activity; Whereas public health professionals collaborate with partners that are not in the health sector, such as city planners, transportation officials, education officials, and private sector businesses, recognizing that other sectors have an important influence on health; and Whereas efforts to adequately support public health and prevention can continue to transform a health system focused on treating illness to a health system focused on preventing disease and promoting wellness; Therefore, be it resolved, by the District Board of Health of Henry County, Ohio, that the following employees and Board member be honored for their roles in preventing disease, promoting wellness, and protecting the health of the residents of Henry County and for their achievement of significant service milestones in 2016: 5 years of service: Peggy Butler, Dr Doug Lindsey, Viola Ordaz, Marianne Shawley, Jennifer Wagner 10 years of service: Megan Burill 15 years of service: Julie McHugh 20 years of service: LouAnn Rosebrock 25 years of service: Julie Lauf Char Weber seconded the motion, and the motion passed unanimously resulting in its adoption. Leaves of Absence without Pay R14.17 Joel Miller moved to approve leaves of absence without pay for the following personnel: a. Sarah DoMoe, approximately 5 weeks (~5/24/17-6/27/17) b. Audrianna Rosebrook, approximately 8 weeks (~7/3/17-8/25/17) Ms. Goon noted both requests are due to the employees not qualifying for Family Medical Leave and not having sufficient paid leave time available. Ms. DoMoe does not meet the requirement for 1,250 hours of time actually worked during the previous 12 months, while Ms. Rosebrook has not been employed by the Health Department for 12 months. The motion was seconded by Sharon Miller. The motion passed unanimously, resulting in its 3

adoption. QUALITY Board of Health Quality Improvement/Accreditation Project Bethany Wachter, Health Communication Specialist/Accreditation Coordinator, shared a survey being conducted by Delaware and Franklin County health departments as part of a Board of Health quality improvement project. It provides an opportunity for boards to provide feedback on communications over the past year. Ms. Wachter identified the survey as an important opportunity to gather Board feedback and provide information regarding Board of Health communication practices at Henry County Health Department for the quality improvement project. Ms. Wachter asked the members to complete the survey and will be compiling results to submit for the project. Joel Miller inquired about the collection of survey results. Ms. Wachter shared the survey data will be anonymous and shared with Delaware County General Health District, who will receive aggregate results from boards of health across Ohio who have participated. This will allow the Board of Health to compare itself with other boards in Ohio. Ms. Goon shared the quality improvement project is a result of the accreditation site visit report received by Delaware indicating communication with the board of health as an area for improvement. Governance Policies R15.17 Ms. Goon presented four governance policies for Board approval, noting the review period for governance policies has now been standardized to three years: 1. Revised General Fund Balance Policy This policy is being revised to reflect the current number of special revenue funds (nine, down from twelve). 2. Revised Special Revenue Fund Balance Policy This policy is being revised to reflect the current names and number of all special revenue funds. A statement was added regarding the maximum balance for Home Health fund and the restriction of this fund per Ohio Revised Code. 3. Health District Fees and Charges Policy This new policy outlines how the Board sets fees and charges for Health District services. Fees are imposed for statutory services such as environmental health and vital statistics. Charges are imposed for non-statutory services the Health District chooses to provide, including immunizations, reproductive health and wellness, home health and hospice. The policy outlines a standard approach to setting fees and charges, as well as exceptions to the standard approach (i.e., when the Board chooses to set a fee or charge at more or less than 100 percent of the full service cost). Ms. Goon noted passage of the policy would delegate authority to the Health Commissioner to update fees and charges throughout the year to ensure coverage of program costs. 4. Revised Delegation of Authority Policy This policy has been revised to reflect the wording included with the Board s approval of out-of-state conference and travel requests each January, noting that the Health Commissioner has the final authority to determine staff attendance based upon available appropriations in the training/travel line item of the pertinent fund, the merit of the conference/program, the cost of attendance, and the workload of the staff involved. Ms. Goon noted this policy would need to be updated to reflect the additional delegation of authority if the Health District Fees and Charges Policy is approved. Joel Miller noted all policies were reviewed by the Personnel/Finance/Audit Committee and the 4

committee recommends approval. Dr. Doug Lindsay moved to approve all four policies, with the revision of the Delegation of Authority Policy to reflect the delegations made in the Fees and Charged policy. Joel Miller seconded the motion. The motion passed unanimously, resulting in its adoption. GROWTH Strategic Plan- Annual Report for 2016 and 2017 Performance Measures Ms. Goon presented the Strategic Plan Annual Report for 2016. The report outlines the 2016 objectives, strategies, and results. Ms. Goon noted the following results for each pillar: 1. People: Objective 1 was to improve employee retention to greater or equal to 80%; 81% of employees were actually retained in 2016. Objective 2 was to measure the Health Department s current financial investment in employee training and development. The management team standardized insite timekeeping codes related to training and development to ensure proper tracking of staff time. Based upon July-December data, the department spent approximately $76,000 in staff time for training and development in 2016 to maintain staff competencies. 2. Service: Objective 1: 96% of internal and external clients strongly agreed they were treated with courtesy and respect, exceeding the 2016 objective of >95%. Objective 2 focused on the timeliness of services. Several quality improvement projects were completed in 2016. These included improving the process to posting website updates, completing timely review of emergency response plans, reducing wait time for the issuance of vital records, and decreasing the amount of time to approve water well permit applications. Objective 3 was to measure the amount of community benefit provided by the Health Department, as measured by personal health care services provided at no cost, reduced cost, or written off due to bad debt or contractual adjustments. Based upon data collected between July and December, community benefit of approximately $710,000 in personal health care services was provided. Ms. Goon stated this demonstrates a significant investment in our residents to ensure they have access to healthcare services. 3. Quality: This pillar focused on safety, effectiveness and efficiency of health department services. Programs were required to complete at least one quality improvement project in one of these three areas. Two projects focused on the safety of staff and/or clients were completed, while two effectiveness and three efficiency projects were also completed. One safety project completed improved the incident reporting process, resulting in more incidents being reported. The request for leave process was streamlined by creating and implementing a new form. An efficiency project completed was the reduction of clerical staff time required to issue certified vital records. 4. Growth: Objective 1 focused on identifying existing capacity within the Health Department to lead public health efforts. A quality improvement team reviewed public health core competency models and the Board of Health adopted the recommended model in October. A Core Competency Assessment was completed in December by all staff; analysis of results will be completed in 2017. Objective 2 focused on working with stakeholders to assess the community s health and implement community health improvement strategies. Department staff worked with community partners to implement 12 strategies, increased the number of Henry County Health Partners to 41 members, and presented Health Department services to five different community organizations in 2016. 5. Finance: This pillar is focused on maintaining funding adequate to provide all essential public health services. Objective 1 emphasized key financial and business management 5

practices: maintaining adequate fund balances, achieving positive operating margins, and spending all available grant funds. The General Fund balance exceeded the minimum required balance throughout 2016; income exceeded expenses. The immunization and Help Me Grow home visiting programs had positive operating margins, while the home health and home health aide programs had slightly higher expenses than income for 2016. The department did not fully spend all grant dollars at the end of 2016, which was difficult to track due to a mix of partial grant years. Objective 2 focused on pursuing at least two funding strategies to support foundational public health services. A 1.2 mill, five year renewal levy was passed in November, and Ms Goon s efforts resulted in $75,000 being awarded to the Mid East Ohio Regional Council to work with the 6-Pact to continue efforts to establish a public health shared services Council of Governments. Objective 3 related to building renovations; an architect was formally engaged in November 2016 and facility renovations plans are in progress. Ms. Goon noted several challenges that occurred during implementation of the strategic plan. The previous strategic plan was more agency-focused, while this plan was created to have more action occur at the program level. This had made it much more challenging to track progress. Four specific revisions will be implemented in 2017: 1. To improve implementation, Marianne Shawley, Quality Improvement Coordinator, will be meeting with project teams quarterly as many teams struggled with completing documentation for projects. 2. The Quality Improvement Plan has been updated to include more communication about projects, including presentations at Board of Health meetings and quarterly Employee Forums. 3. Project teams must meet the documentation requirements outlined in the plan to receive credit for achieving performance measures. 4. The process for setting performance measures will begin earlier in the fourth quarter rather than waiting for results to set new measures. Ms. Goon shared an overview of the implementation plan for 2017 including the agency objectives, strategies, and individual program performance measures. It was noted that many items were continued for monitoring purposes or where performance measures indicated continued improvement was necessary. A stretch goal was incorporated for nearly every program to encourage the use of quality improvement. Agency performance measures were shared at Employee Forums in February and finalized program measures were sent to staff this week. Joel Miller stepped out of the meeting at 12:53pm and returned at 12:55pm. Discussion Regarding Public Health-related Items in Governor s Biennial Budget Proposal Ms. Goon highlighted public health-related items proposed in Governor Kasich s State Budget for July 1, 2017- June 30, 2019. The budget initiatives fall into 4 areas: 1) Modernize Medicaid to provide high-value health care coverage for very low-income Ohioans; 2) Streamline Health and Human Services by sharing services across jurisdictions to improve performance; 3) Pay for Value to reset the basic rules of health care competition to reward value; and 4) Improve Population Health to make Ohio a model of health and economic vitality. Proposals that will most directly impact local health departments are found in the Improve Population Health area. Governor Kasich is proposing doubling the state subsidy for accredited health departments from 19 to 38 per capita. This provides some recognition of the achievement of accreditation by the state. There is additional technical support for accreditation in the proposed budget, including performance management trainings. The proposed budget also supports health 6

departments who are pursing mergers to achieve accreditation by providing funds for accreditation fees, accreditation coordination, and other infrastructure costs. The budget provides the ability for multi-county health district boards to place multi-county levies on the ballot, which may assist in funding a merged multi-county health district. The budget proposes extending the deadline for achieving accreditation from 2020 to 2021 for health departments who merge between January 1, 2016, and July 1, 2019. It also includes one-time $12,500 grants to assist health departments in moving from the Public Health Accreditation Board s 5-year community health assessment cycle to the 3-year cycle being required by the state. Ms. Goon and Julie Lauf, Director of Personal Health Services, also shared proposed changes to the Bureau of Children with Medical Handicaps (BCMH) program (now called Children with Medical Handicaps or CMH) in Governor Kasich s proposed budget. CMH pays for health care services for children with special needs who are uninsured, underinsured, or whose insurance does not cover the services they need. Ms. Lauf shared the program currently is managed and coordinated by local public health nurses in each county. The nurse assists the family with getting children s conditions diagnosed and treated, finding a CMH provider, and linking them to needed services. The program serves as the payer of last resort. The Governor proposes to move the program to Ohio Medicaid for all children enrolling after July 1, 2017, which may eventually eliminate the care coordination and case management services provided by public health nurses. Bob Hastedt, Henry County Commissioner, shared this change and other Medicaid changes will affect the county, including the loss of sales tax from Medicaid Managed Care Organizations (MCOs). Ms. Goon noted if the Children with Medical Handicaps (CMH) program moves to Medicaid, the county will no longer be responsible for paying for these services. Ms. Lauf noted that a white paper has been written regarding these changes. Ms. Goon will send this document to the Board members after the meeting. FINANCE Approval of Bills The Board of Health reviewed February bills. Char Weber moved February bills be approved for payment. Marilyn Bremer seconded the motion. The motion passed unanimously, resulting in its adoption. Approval of Intrafund Transfer R16.17 Sharon Miller moved that the Henry County Auditor be requested to make the following Intrafund Transfer: a. $5,000.00 from 5060-5200-51110 (Transfer) to 5060-5200-50040 (Supplies) CFHS Joel Miller seconded the motion. The motion passed unanimously, resulting in its adoption. Approval of Cash Transfer R17.17 Marilyn Bremer moved that the Henry County Auditor be requested to make the following Cash Transfer: a. $1,259.00 from 5020-5200-51110 Appropriation (Transfer-Home Health Aide) to 5000-5200-40490 Revenue (Transfer-Health) Char Weber seconded the motion. The motion passed unanimously, resulting in its adoption. 2018 Budget Appropriations R18.17 Ms. Goon presented the proposed 2018 Henry County Health District Budget Appropriations and supporting rationale. The Personnel/Finance/Audit Committee met March 8 to review the proposed 2018 budget appropriations. Total appropriations for all funds combined equal 7

$4,409,120, a 5.5% increase from 2017 appropriations. $475,000 of General Health carryover funds have been budgeted for building renovation costs. Without the renovation funds, the appropriations for 2018 are 6% less than those budgeted for 2017. Joel Miller noted the Personnel/Finance/Audit Committee reviewed the appropriations in detail and recommends approval. Joel Miller moved that the 2018 Health District Budget Appropriations be approved and certified to the County Auditor to be submitted to the County Budget Commission. The motion was seconded by Al Wiederwohl and passed unanimously. Acceptance of Revised Grant Notice of Award and Related Budget R19.17 Dr. Doug Lindsay moved to accept a revised Notice of Award (NOA) and the related program budget; 1. Revised NOA for Reproductive Health and Wellness Program (4/1/16-3/31/17)- Ohio Department of Health ($94.800.00) This revised NOA provides an additional $4,800.00 for Reproductive Health and Wellness Program services. These funds will be used to purchase additional equipment. Char Weber seconded the motion. The motion passed unanimously, resulting in its adoption. Approval of Contract R20.17 Marilyn Bremer moved to approve the following contract: 1. Contract for Human Trafficking Awareness Campaign Billboards- Lamar Companies ($1,680.00) The Human Trafficking grant includes community awareness activities, including billboards. Joel Miller asked if the campaign was a requirement by the state. Ms. Goon stated the campaign is included in the grant received and is not a state requirement. Dr. Lindsay inquired about the process and pricing to place billboards. Ms. Goon shared the billboards will be placed based on availability and location. Pricing is determined by the amount of traffic, location, and lighting of the billboard. Sharon Miller seconded the motion. The motion passed unanimously, resulting in its adoption. Building Renovations Committee Ms. Goon requested two Board members serve as volunteers on the building renovations committee, which will be comprised of several managers, staff, and Board members. Management, with staff input, have worked with Technicon Design Group architects to develop a layout for the building renovation. The committee would continue to oversee the renovation process. Char Weber and Sharon Miller volunteered to serve on the building renovations committee. EXECUTIVE SESSION: EMPLOYMENT AND COMPENSATION OF A PUBLIC EMPLOYEE Char Weber moved to go into Executive Session at 1:32 pm for employment and compensation of a public employee. Dr. Doug Lindsay seconded the motion. The motion was passed by roll call vote: S. Miller (Yes), R. Richard (Yes), J. Miller (Yes), A. Wiederwohl (Yes), C. Weber (Yes), Dr. D. Lindsey (Yes), and M. Bremer (Yes). Health Commissioner Anne Goon participated in this session. There being no further business to discuss in Executive Session, the Board of Health returned to regular open session at 2:03 pm. 8

ADJOURNMENT There being no further business, Roger Richard called for a motion to adjourn at 2:03 pm. Char Weber moved for adjournment, and Al Wiederwohl seconded the motion. The motion passed unanimously. The next regular Board of Health meeting was scheduled for Wednesday, March 15, 2017, at 12:30 p.m. Roger Richard, President Anne Goon, Secretary 9